What is your approach for persistent and romiplostim-refractory thrombocytopenia after temozolomide with radiation in a patient with recurrent GBM?

Even if bone marrow does not show leukemia, I would consider checking for CHIP or CCUS variants. I would probably not have a high index of suspicion for immune mediated thrombocytopenia related to TMZ in this context. Beyond transfusion, time, TPO-RA and supportive care, I am not sure there are many...